As the nation continues to struggle toward solutions of health equity, there is a large gap in the dialogue: the importance of strengthening and supporting community birth centers. Earlier this month, the North Shore Birth Center in Beverly closed, leaving only one birth center standing in the state. As a result, Massachusetts is now ranked 33rd in the country for birth centers, where more than 32 other states have at least two birth centers.
Birth centers are freestanding health care facilities based on a wellness model, where babies are delivered by midwives, care is often covered by insurance, and women can be transferred to a hospital if needed. Research shows that births attended by nurse midwives are not only safe but have improved outcomes, including fewer deaths of mothers, fewer complications, fewer medical interventions, and saved medical costs. The National Partnership for Women & Families estimates that if just 10 percent of births moved from hospitals to birth centers, there would be $189 million of annual savings to the health care system. What’s more, studies show that birth center care grounded in racial justice improves autonomy and respect for all birthing people and is protective for Black birthing people.
So why the disconnect between this evidence-based care model and the current health care landscape? Prioritizing hospitals and obstetricians for childbirth was an economic decision made at the turn of the 20th century that was never redressed. This decision, one that undermined community midwives and moved childbirth into the hospital, changed the maternity care system — 99 percent of people give birth in a hospital despite the fact that 85 percent of people who birth in hospitals are considered low risk and could birth safely in a community setting. Additionally the United States does not guarantee home visits or paid parental leave postpartum — a time of high risk for mortality. The burden of the maternal mortality rate in our country falls squarely on the shoulders of Black women and their families as Black women are three times as likely to die from pregnancy-related causes as white women.
Meanwhile, utilization of community birth settings is trending upward. According to the National Partnership for Women and Families, the increase in people choosing to give birth in their communities was greatest for Black parents (30 percent), followed by indigenous (26 percent) and Hispanic (24 percent) parents. This despite the fact that these are the communities least likely to have access to these options.
For more than 40 years, community leaders have imagined a top-notch birth center in Boston where people could receive full-spectrum midwifery care covered by insurance. The center would also support people beyond childbirth with postpartum care, lactation support, mental health support, and gynecology services.
This vision is a direct response to the last century of over-medicalization of childbirth, increased threats to reproductive health, and persistently poor rates of maternal health outcomes that bear down inequitably on communities of color. And this vision is now becoming a reality. Within two years, the Neighborhood Birth Center will open its doors in Roxbury, just minutes from Boston Medical Center (the receiving medical center in the unusual case of a need for an emergency transfer).
Despite the hope that the center provides in improving outcomes and experiences as well as saving costs, the opening is far from a fairy tale. State regulations are stifling for community birth centers and low insurance reimbursement for midwifery care is a threat to the bottom line. With the closing of the North Shore Birth Center and the stalled reopening of the Cambridge Birth Center (both part of hospital systems and not independently operated), it seems that midwifery care is often seen as dispensable.
But everyone is born, and as Alice Walker said: “How we come into this world, how we are ushered in, met, and hopefully embraced upon arrival, impacts the whole of our time on earth.” Fighting for birth centers, where care is grounded in justice and equity, improves outcomes, autonomy, and respect for all birthing people.
Nashira Baril is the executive director of Neighborhood Birth Center and co-founder of Birth Center Equity. Dr. Katherine Gergen Barnett is vice chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center, a clinical associate professor at BU Chobanian & Avedisian School of Medicine, an associate at Harvard’s Center for Primary Care, and a health innovator fellow at the Aspen Institute. Dr. Mallika Sabharwal is a family medicine physician and preventive medicine fellow at Boston Medical Center.